Steven Lyle Wagner
Individual provider Active NPI Pharmacist · Washington Park, IL
NPI 1679460778 · NPPES record last updated Jun 20, 2025
Key facts
- NPI
- 1679460778
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051031829 (IL)
- Practice address
- 1833 Kingshighway
Washington Park, IL 62204 - Phone
- (618) 874-3000
- Fax
- (618) 674-3103
- NPI assigned
- Jun 20, 2025
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051031829 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medicate Pharmacy Inc | Past |
Accepting new patients | |
| Medicate Pharmacy Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051031829 | IL | Yes |
Addresses
Primary practice location
1833 Kingshighway
Washington Park, IL 62204
Mailing address
1833 Kingshighway
East Saint Louis, IL 62204-2135
Phone (618) 874-3000
Other providers in Washington Park, IL
- Medicate Pharmacy Inc
- Michael Lee Schaltenbrand
- Scott Christopher Schultz
- Southern Il Regional Wellness Center
- Southern Illinois Regional Wellness Center
- Linda Wallace
All providers in Washington Park, IL · Pharmacist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.